Types 1 diabetes

Question 1

What is T1DM?

Answer 1

An autoimmune condition where insulin producing islet cells of the pancreas are destroyed by auto antibodies, resulting in hyperglycaemia and insulin deficiency

Question 2

What are Sx of T1DM?

Answer 2

Sx of hyperglycaemia include fatigue, difficulty concentrating, polyuria, polydipsia, dehydration e.g. dry mucus membranes

Sx of insulin deficiency include weight loss, weakness, growth retardation

May present as DKA.

Usually in kids

Question 3

What are risk factors for T1DM?

Answer 3

Other autoimmune disease
White
Geography e.g. Finland, UK
Young

Question 4

What Ix in diabetes?

Answer 4

Fasting blood glucose

OGTT

HbA1c

Plasma or urine ketones

Glycosuria

Consider:
Autoantibodies

HLADR3/4 positive in 90%

C peptide -ve

Question 5

How is diabetes diagnosed?

Answer 5

Either: symptoms of hyperglycaemia and raised fasting/random/OGTT glucose on one occasion,

OR

Raised fasting/random/OGTT glucose on 2 occasions

Question 6

What are DDx for T1DM?

Answer 6

other diabetes mellitus
Diabetes insipidus
MODY

Question 7

What is Rx of T1DM?

Answer 7

Insulin therapy: basal bolus regimen

Blood glucose monitoring

Question 8

What are different types of insulin therapy?

Answer 8

Rapid: novarapid (aspart) and insulin lispro. This can be given before meals if glucose is high.

Short: actrapid

Int: humulin I

Long: levemir, lantus, tresiba

Pre-mixed e.g. novomix, humulin M3

Insulin pumps can be used for continuous infusion

Question 9

What is a VRIII?

Answer 9

Variable rate IV insulin infusion, used in hospital inpatients with DKA, HHS, hyperglycaemia, to achieve normoglycaemia